<?php
if (isset($breadcrumb) && !empty($breadcrumb)) :
	echo $this->element('breadcrumb');
endif;
?>
<div class="pad group">
	<div class="post-list group">
		<div id="respond">
			<h4 class="blue"><i class="fa fa-edit"></i> Đăng ký công chứng với văn phòng công chứng Âu Lạc</h4>
			<?php echo $this->Form->create('Contact', array('id' => 'Contact', 'class' => 'rnd5'));?>
			<table class="table table-striped table-bordered table-hover" id="dataTables-example">
				<tr>
					<th width="30%">Họ và tên <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->input('name', array(
								'type' => 'text',
								'label' => false,
								'class' => 'form-control w400',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th width="30%">Địa chỉ <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->input('address', array(
								'type' => 'text',
								'label' => false,
								'class' => 'form-control w400',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th>Điện thoại <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->input('phone', array(
								'type' => 'text',
								'label' => false,
								'class' => 'form-control w100',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th>Email <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->input('email', array(
								'type' => 'email',
								'label' => false,
								'class' => 'form-control w400',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th>Tiêu đề <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->input('subject', array(
								'type' => 'text',
								'label' => false,
								'class' => 'form-control w400',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th>Nội dung <span class="require red"> *</span></th>
					<td>
						<?php
						echo $this->Form->textarea('message', array(
								'label' => false,
								'rows'=> 4,
								'cols' => 70,
								'value'=>'',
								'required' => true,
						));
						?>
					</td>
				</tr>
				<tr>
					<th width="20%">Mã bảo mật <span class="require red"> *</span></th>
					<td>
						<?php echo $this->Captcha->input();?>
						<?php echo $this->Session->flash();?>
					</td>
				</tr>
				<tr>
					<th>&nbsp;</th>
					<td>
						<div class="form-group">
						<?php
						echo $this->Form->button('Liên hệ', array(
								'type' => 'submit',
								'class' => 'btn btn-primary',
								'label' => false,
								'div' => false,
							)
						).'  ';

						echo $this->Form->button('Làm lại', array(
								'type' => 'reset',
								'class' => 'btn btn-primary',
								'label' => false,
								'div' => false,
							)
						);
						?>
						</div>
					</td>
				</tr>
			</table>
			<?php echo $this->Form->end()?>
		</div>
	</div>
</div>
<div class="clear"></div>
